NEXT Generation Health Study - NICHD

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2 Peer Online Survey	Form and Instruction	New	Available
Form 2 Administrator Survey	Form and Instruction	Removed	Available
Form 8 Parent In-Home Survey	Form and Instruction	Removed	Available
Form 10 survey	Form and Instruction	Removed	Available
Form 9 survey	Form and Instruction	Removed	Available
Form 1 Participant Online Survey	Form and Instruction	Modified	Available
SSB 2012.doc	Supporting Statement B	Uploaded 2012-11-14	Available
Attachment 9 Certificate of Confidentiality.pdf	Supplementary Document	Uploaded 2012-11-14	Available
Attachment 8 ITSSP 2012.pdf	Supplementary Document	Uploaded 2012-11-14	Available
Attachment 6 Informed Consent - Parents of Peers 2012.doc	Supplementary Document	Uploaded 2012-11-14	Available
Attachment 5 Informed Consent Peer Survey 2012.doc	Supplementary Document	Uploaded 2012-11-14	Available
Attachment 4 Informed Consent - 18+2012.docx	Supplementary Document	Uploaded 2012-11-14	Available
Attachment 3 Source Table for Survey Items 2012.xls	Supplementary Document	Uploaded 2012-11-14	Available
Attachment 2A Peer Survey Hard Copy.doc	Supplementary Document	Uploaded 2012-11-14	Available
Attach 6.doc	Supplementary Document	Uploaded 2009-09-24	Available
Attach 4.doc	Supplementary Document	Uploaded 2009-09-24	Available
Attachment 1A Participant Hard Copy Survey 2012.doc	Supplementary Document	Uploaded 2012-11-14	Available
SSA 2012.doc	Supporting Statement A	Uploaded 2012-11-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204847	Peers recruited	Form and Instruction	New	Peer Online Survey
190914	School Administrators	Form and Instruction	Removed	Administrator Survey
190913	Parents	Form and Instruction	Removed	Parent In-Home Survey
190912	Adolescents with Additional Assesments	Form and Instruction	Removed	survey
190912	Adolescents with Additional Assesments	Form and Instruction	Removed	survey
190911	Young Adults	Instruction	Modified
190911	Young Adults	Form and Instruction	Modified	Participant Online Survey

ICR Details

OMB Control No: 0925-0610	ICR Reference No: 201211-0925-007
Status: Historical Active	Previous ICR Reference No: 200910-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: NEXT Generation Health Study - NICHD
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/03/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/15/2012
Terms of Clearance: Previous terms continue: The program will collaborate with Department of Education investigators involved in school based research.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2016	36 Months From Approved	04/30/2013
Responses	4,635	0	4,280
Time Burden (Hours)	3,790	0	4,054
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this OMB application is to permit continued collection of longitudinal health behavior and health status data in this cohort of U.S. adolescents for four more years. In addition, up to six best friends nominated by the NEXT Plus cohort in 2013 and 2015 will complete brief surveys of their health behaviors. This is a revision of the previous application because there is a new group of respondents and a revision of the survey forms

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Authorizing Statute(s): US Code: 42 USC 285g Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 10758	02/23/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 67823	11/14/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Adolescents with Additional Assesments	9, 10	survey ,   survey
Parents	8	Parent In-Home Survey
Peers recruited	2	Peer Online Survey
School Administrators	2	Administrator Survey
Young Adults	1	Participant Online Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	4,635	4,280	0	955	-600	0
Annual Time Burden (Hours)	3,790	4,054	0	-339	75	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: This is a revision of an OMB approved longitudinal study. The revision is the collection of survey data from friends of the primary participants. These data are essential for identifying social influences on the health, health behaviors, and health risk behaviors of the cohort being studied.

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Annual Cost to Federal Government: $1,740,456

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/15/2012

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